Search

Introduction: In children, the pelvis contains a large amount of cartilage components; therefore, when traumatic hip dislocation spontaneously reduces, it can be impossible to see on X-ray or computed tomography (CT) images in some cases, which can delay its detection., Case Presentation: We report the case of a 10-year-old boy who was injured by being hit by a car while walking. Upon diagnosis of pelvic ring fracture, the patient received conservative treatment. Seven months after injury, the patient was referred to our department with the chief complaint of limping., Diagnosis: Marked limitation was observed in the left hip with extension of -40°, abduction of 10°, and internal rotation of 20°. X-ray revealed narrowing of the left hip joint space, with deformity of the femoral head, obturator foramen narrowing, and the break in the Shenton line. CT revealed proximal dislocation of the posterior acetabular wall and posterior subluxation of the femoral head. Magnetic resonance imaging (MRI) revealed necrosis of the femoral head., Intervention: Operation was performed with soft tissue dissection, varus-extension-internal rotation femoral osteotomy, greater trochanteric epiphysiodesis, and pelvic osteotomy (incomplete periacetabular osteotomy: IPO). After operation, complete paralysis of the sciatic nerve was observed., Outcomes: At 1 year after operation, the patient's limited range of motion (ROM) and femoral head necrosis had improved. The sciatic nerve paralysis had fully recovered., Conclusion: If hip extension, abduction, and internal rotation are limited and X-ray reveals a break in the Shenton line., subluxation of the hip should be suspected., Competing Interests: None., (© 2020 The Authors.)

Introduction: The treatment strategies for residual deformity of Perthes disease are not established., Case Presentation: This is a case report of a 15-year-old boy. He developed right Perthes disease (lateral pillar classification group B) when he was 10 years old and underwent varus femoral osteotomy of the right side. At 12 years of age, he developed left Perthes disease (lateral pillar classification group B) and underwent varus femoral osteotomy of the left side. Postoperatively, he was treated with partial weight bearing of the left leg with crutches. At 15 years, range of motion (ROM) of his left hip was markedly limited at 30° flexion, 10° abduction, 70° external rotation, and -20° internal rotation, and he was having difficulty maintaining a sitting position., Diagnosis: Stulberg group V was noted on plain radiography. Computed tomography (CT) showed collapse of the load-bearing part of the femoral head on the coronal plane, but the ball-shape was maintained in the posterior femoral head on sagittal and transverse sections., Intervensinos: Valgus-flexion-internal rotation osteotomy was performed to improve ROM., Outcomes: Left hip ROM improved to 90° flexion, 20° abduction, 50° external rotation, and 40° internal rotation immediately after the surgery. He was able to sit 10 months postoperatively but was left with a limp and limited ROM in the left hip at 60° flexion. Chondroplasty was performed during the plate removal surgery at 10 months postoperatively, which improved hip flexion to 100° immediately after the surgery. The patient was left with limited ROM of 60° flexion of the left hip at the final observation., Conclusion: Femoral osteotomy to improve ROM could be an option for residual deformity of Perthes disease., Competing Interests: The authors declare that they have no known competing interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 The Author(s).)

Introduction: The most cases of excessive femoral anteversion may be asymptomatic, because the he hip joint is a ball joint. However, when the hip, knee, or ankle joint is in a pathological state, excessive femoral anteversion may not be compensated for and induce symptoms., Case Report: A 16-year-old female with achondroplasia. Medullary compression by the odontoid process caused right hemiplegia at 10 months after birth and equinus foot concomitantly developed. At 14 years old, right knee pain developed during walking. For treatment, firstly, tenodesis of medial collateral ligament of the knee joint (MCL) was performed. Oblique osteotomy was applied to the proximal MCL attachment site over the distal tibial tuberosity, followed by simple limb lengthening, which improved knee instability. To prevent recurrence of knee instability, varus and derotationosteotomy of the femur and Vulpius procedure (triceps surae muscle lengthening) were additionally performed, and gait stabilized after surgery., Discussion: Regarding the pathogenesis, her gait was originally in-toeing because of excessive femoral anteversion, but the lower leg did not internally rotate during walking because of equinus foot, and the foot grounded in an externally rotated position, loading burdens on the MCL. This condition may have gradually caused instability of the knee over the years., Conclusion: We surgically treated the patient with knee joint valgus instability caused by excessive femoral anteversion and equinus foot and achieved a favorable outcome.